Biomedical subjects
Publications and source records attributed to G Wittrin.
A case of hereditary spherocytosis is described in a casuistic report where the clinical picture of polycythaemia appeared 5 years after a successful splenectomy. The possibilities of a coincidence of diseases, a postsplenectomy reaction or a genuine myeloproliferative syndrome as the cause underlying a secondary disease are discussed.
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With islet cell transplantation it would be possible to achieve a generally improved treatment of diabetes mellitus and avoid late complications. Since the problems of preparation, conservation and implantation of the islet cells have been satisfactorily solved, it ought to be possible to master the immune reaction in the future. The successful progressive development of islet cell transplantation in recent years justifies this optimism.
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In 19 patients with a carcinoma of the pancreas an intraoperative occlusion of the pancreatic duct was performed with a partial duodenopancreatectomy by instillation of Ethibloc. In 13 cases a carcinoma of the papilla and in 6 cases a carcinoma of the head of pancreas were found. In two cases the duct was primarily closed by suture, which was followed by a pancreatic fistula that disappeared after 2 weeks. Therefore, a pancreaticojejunal anastomosis was performed in the other patients. One patient died owing to a total necrosis of the remaining pancreas, but no other local complications were seen at the time of pancreatic anastomosis. Lethality was approximately 5% and was therefore significantly lower than in other reports.
The low-dose heparin prophylaxis depends upon a low-level activation of antithrombin III to prevent thrombin generation. For the routine regiment, the application of 5000 units twice daily seems sufficient to reduce fatal lung embolism. By comparing three commercially available heparins (Thrombophob, Thrombo-Vetren, Heparin-Dihydergot) the effectiveness of the so-called low-dose heparin application was controlled with a chromogenic substrate assay (Coatest, Kabivitrum). Only twice-daily Heparin-Dihydergot resulted in an average heparin level of 0.12 +/- 0.78 m/ml plasma, which was sufficient to provide an effective thrombosis prophylaxis.
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The level of factor XIII circulating in the blood plasma was determined with a commercially available screening method of the Behringwerke, Marburg, Germany. In a randomized study, the blood of 76 of both sexes and different ages was analyzed before and after surgery. In most extensive laparotomies, factor XIII declined as an expression of the vascular processes during and after the operation. The same effect was demonstrated after surgical excision of stomach or of colon carcinomas. Concurrent with the factor XIII level, fibrinogen concentration was also reduced. While the replenishment of factor XIII extended over a period of several days postoperatively, the fibrinogen synthesis was increased and exceeded normal levels after 2 to 3 days. Inspite the operational activities, factor XIII was never so low that a substitution was indicated.
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Obliterating arteriosclerotic lesions of pelvic vessels may induce inflammation and fibrosis of the rectum and subsequently ischemic proctitis. This may lead to damage of the sphincter muscle and to complete incontinence. Clinical symptoms are pain and bloody stools, as in ischemic colitis. The combination of periproctitis and perianal necrosis may be misinterpreted as anal fistulas. An anus praeter sigmoideus is to be recommended for palliation. A case report of this particular disease is given including clinical, angiographic and morphological data.
Reported in this paper are two case of ovarian vein thrombosis which were incidentally discovered, when caesarean section was performed. The two thromboses must have originated at some point during pregnancy. This observation is very rare, since ovarian vein thrombosis is generally known for its occurrence as a complication during the puerperium. The ovarian vein was proximally ligated close to the uterus, and the motivations for this approach are given. Treatment then was continued with heparin. The incidence postpartum of ovarian vein thrombosis accounted for one per cent of alle diagnoses to which reference is made in this paper.
Acute pancreatitis was induced in 30 minipigs (Göttingen) by implantation of a T-drain into the Ductus Wirsungianus. The distal part of the T-drain, which led into the duodenum was stenosed to 1/3 of the original diameter. The inflammation was caused by stenosis of the Ductus Wirsungianus additionally by application of contrast medium. The course of the inflammation was demonstrated by biochemical, roentgenological and histological examinations.
Echinococcus cysticus is a parasite; the human organism is invaded by cysticercus of the dog tape worm. In liver 60% of all viable embryos are retained, 30% in the lung, the last 10% spread via the arterial system into all other organs. Diagnosis can be established by serology, sonography, scintigraphy as well as invasive and non-invasive radiological examinations. Case reports of 20 patients with Echinococcus cysticus are given; the disease was localized 16 times in the liver, 3 times in the lung and once in the spleen. Drugs or x-ray treatment have no sufficient therapeutical effect. Trivial trauma can cause rupture of the cysts; therefore surgery is indicated.
In inoperable stenosing tumours of the oesophagus the problem arises of maintaining oral food intake. As malignant cells are more cold-sensitive than normal cells oesophageal tumours may be "cold-coagulated" with special probes. Preliminary results with this treatment in 28 patients are reported.
3 cm of the common bile duct was removed in 19 dogs and the defect was bridged by an autologous vein. The interposition of a vein graft was performed with a double end-to-end anastomosis. In four cases a T-drain was additionally placed into the transplant. GOT, GPT, LDH, AP and bilirubin were tested in regular intervals. The patency of the transplant was proved by radiography with dogs which survived longer than 6 weeks. 5 dogs died within the first 4 weeks, 4 were killed after 2 months, because of incrustation of the T-drain for a regular percutaneous rinsing of the drainage was not possible. 10 dogs survived for 6 to 12 months. These animals showed increasing laboratory results up to two months, then the tests normalized. The function of the transplanted vein was without complication and the liver histology did not show any pathological alteration. After two months the transplanted vein was bridged by bile duct epithelium.
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